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Nursing Obstetrics & Pediatrics > alterations in GI functions > Flashcards

alterations in GI functions Flashcards

1
Q

how is the anatomy and physiology of children’s GI tract different than adults?

A
  • immature until about 2 years of age
  • deficient in amylase, lipase, and trypsin until 4-6 months of age
  • smaller stomach capacity and greater intestinal motility
  • liver function is immature
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2
Q

what are possible causes of GI disorders?

A
  • a congenital defect
  • acquired disease
  • infection
  • injury
  • structural problems (usually occur in 1st trimester when GI is developing)
  • inflammatory disorder
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3
Q

what is necrotizing enterocolitis?

A
  • an inflammatory disorder
  • death of tissue in the small or large intestine because of inflammation
  • may be caused by intestinal ischemia, bacterial or viral infection, immaturity of GI mucosa
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4
Q

why does necrotizing enterocolitis occur more commonly in premature infants?

A
  • weaker immune systems

- less time to develop

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5
Q

what are the symptoms of necrotizing enterocolitis

A
  • manifests between 3-14 days of life up to 3 months old most commonly
  • general signs of being sick
  • vomiting and increased gastric residual
  • irritability and lethargy
  • abdominal distention
  • bloody stools
  • temperature instability
  • rapid progression of shock
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6
Q

what is an ileostomy?

A
  • a surgically-created opening in the abdomen through which the end of the ileum is brought up to the surface of the skin to provide an outlet for feces when a bowel obstruction or non-functioning structure prevents normal elimination
  • may also be done to “rest” an area lower down after surgery
  • can be temporary or permanent
  • when temporary, there are often two holes
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7
Q

what are indications that may result in an ileostomy?

A
  • bowel infections
  • bowel injuries
  • bowel obstruction
  • cancer
  • conditions that cause severe bowel inflammation
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8
Q

Central venous catheters are often used for TPN with pediatric patients, what are the 5 types of CVLs?

A
  • short term, percutaneous
  • tunneled
  • PICC (peripherally inserted central catheters)
  • implanted
  • hemodialysis
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9
Q

what are complications that may occur with central venous lines?

A
  • infection
  • bleeding
  • can be pulled out
  • can become occluded
  • can get an air emboli
  • can be damaged
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10
Q

why are CVLs used for TPN on pediatric patients?

A
  • children are often hard to poke
  • TPN is hard on veins and easily lost
  • TPN requires daily blood work, another reason to have a CVL!
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11
Q

why is total parenteral nutrition used?

A
  • to provide intravenous nutritional support
  • fluids usually contain glucose, amino acids, electrolytes, vitamins, proteins, and lipids
  • tailored to meet needs of pediatric patient
  • can be used as primary therapy, adjunctive or sole source
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12
Q

what is the normal range for WBCs?

A

4.0-11.0

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13
Q

what is the normal range for Hgb

A

135-175

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14
Q

what is the normal range for platelets?

A

100-400

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15
Q

what is the normal range for MCV?

A

0.40-0.54

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16
Q

what is the normal range for sodium?

A

135-145

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17
Q

what is the normal range for potassium

A

3.5-5.1

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18
Q

what are complications associated with a cleft lip and/or palate?

A
  • susceptibility to colds
  • hearing loss
  • speech defects (this can be helped by early surgery)
  • larger than average number of dental cavities, missing/extra/malformed or displaced teeth
  • otitis media because eustachian tubes don’t drain fluid properly from middle ear into throat
  • feeding dificulties
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19
Q

what is hirschprung?

A

a congenital aganglionic megacolon

  • the absence of autonomic parasympathetic ganglion cells of the colon that prevents peristalsis at that portion of the intestine
  • can lead to obstruction
20
Q

what is a tracheosophageal fistula

A

an abnormal opening between the trachea and esophagus

21
Q

what are some complications that can occur in premature infants?

A
  • apnea
  • patent ductus arteriosus
  • intraventricular hemorrhage
  • retinopathy of prematurity
  • anemia because RBC life is shorter in infants than other children
  • respiratory distress syndrome
22
Q

how is liver damage detected?

A

it can be detected by simple blood work that looks for presence of certain liver enzymes in the blood
-under normal circumstances they reside in the cells of the liver, but when liver is injured, they enter the blood

23
Q

what are the normal ranges for liver enzymes?

A

AST 5-40 units per litre of serum
ALT 150-500 units per litre of serum
Bilirubin 3-22 units per litre of serum

24
Q

how is necrotizing enterocolitis diagnosed and treated?

A
  • septic workup
  • radiographs
  • NPO
  • NG for drainage
  • maintain fluid balance
  • TPN (done if fluid balance can’t be maintained or treatment takes long)
  • antibiotics if septic
  • possible bowel resection
  • ileostomy or colostomy
  • isolations
25
Q

what are some nursing interventions for a bowel obstruction?

A
  • IV maintenance
  • NG tube insertion
  • monitor abdominal girth
  • abdominal x-ray
  • antibiotics
  • monitor blood tests
  • monitor stool
26
Q

what is involved in medical treatment for a bowel obstruction?

A
  • surgery - temporary or permanent ostomy
  • feeding gradually to prevent refeeding problems
  • management of infections and hydration
27
Q

what is refeeding syndrome?

A
  • metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved, malnourished, or metabolically stressed
  • potentially fatal shifts in fluids and electrolytes
  • hypophosphatemia
  • abnormal sodium and fluid balance
  • changes in metabolism of fat, protein, and glucose
  • thiamine deficiency
  • hypokalemia
  • hypomagnesaemia
28
Q

what are some long-term complications of NEC?

A
  • malabsorption
  • short bowel syndrome
  • scarring and narrowing of bowel causing obstruction
  • scaring within the abdomen causing later pain and possible female infertility
  • problems relating to long-term use of TPN including cholestasis
29
Q

what is cholestasis?

A
  • a reduction or stoppage in bile flow
  • bile flow is a digestive fluid and without it bilirubin escapes into bloodstream and accumulates
  • common symptom is jaundice, dark urine, light-colored stools, itchiness
  • calcium and vitamin d are poorly absorbed because of lack of bile in intestine
  • vitamin K is also then poorly absorbed from intestine and can lead to clotting problems and bleeding
30
Q

what is short bowel syndrome?

A

-too little bowel present to absorb all the nutrients needed by the body

31
Q

what is a cleft palate?

A

-where the maxillary processes fail to fuse

32
Q

how is a cleft lip and palate diagnosed?

A
  • cleft lip is apparent at birth and often easy to diagnose
  • cleft palate defects can be less obvious, especially when they do not present with a cleft lip
  • palate should be palpated to look for defects, however signs may be feeding issues or recurrent infections r/t food entering where it shouldn’t be
33
Q

how is a cleft lip treated?

A

surgery, usually done within 2-10 weeks of birth

34
Q

how is a cleft palate treated?

A

surgery, usually between 6-18 months of age

35
Q

what are some potential nursing diagnoses related to cleft lip and/or cleft palate?

A
  • potential for inadequate nutrition
  • potential for infection
  • potential for inadequate fluid intake
  • potential for bleeding or pain post-op
36
Q

what are some post-operative nursing interventions for nurses for a patient with a cleft palate repair?

A
  • airway management due to post-op edema
  • arm restraints to protect incision
  • wound management
  • cleaning site with sterile water after each feed
  • crusting can increase scarring, want to keep incision looking as good as possible
  • keep feeds under 60 minutes
37
Q

what medications may be used post-operatively for cleft lip/palate repairs?

A
  • morphine
  • tylenol
  • gravol
38
Q

what is a tracheoesophageal fistula?

A

an abnormal opening between the trachea and esophagus

39
Q

what is esophageal atresia?

A

a congenital defect where upper esophagus fails to connect to lower esophagus and stomach before birth

-can simply dead end, but more commonly coexists with tracheoesophageal fistula

40
Q

how is a tracheoesophageal fistula and or esophageal atresia diagnosed?

A
  • may include maternal history of hydramnios
  • pt history of vomiting
  • may be unable to pass an NG tube which is how it is noticed
  • barium swallow test is used for official diagnosis of what is going on
41
Q

how is a tracheoesophageal fistula and/or esophageal atresia treated?

A
  • surgery to close fistula and/or connect esophagus

- oral feeds stopped and intravenous fluids started or TPN depending how long diagnosis and treatment takes

42
Q

what is an imperforated anus?

A

an obstruction of the passage of fecal matter by a structural anomaly of the anus and rectum

-may occur with or without a fistula

43
Q

how does rectal atresia present clinically?

A

-failure to pass meconium and abdominal distention

44
Q

how is an imperforate anus diagnosed?

A
  • visual inspection of perineum
  • xray
  • retrograde urethrocystogram used to diagnose or rule out rectourethral fistual
45
Q

what is intussusception?

A

when one portion of bowel slides into the next, can lead to decreased blood flow and necrotic tissue

46
Q

how is an intussusception treated?

A
  • may try a barium enema to expand area using fluid

- may require surgery

Nursing Obstetrics & Pediatrics (26 decks)

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